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Overview
A hammer toe can be defined as a condition that causes your toe to bend downward instead of pointing forward. While it can occur on any toe on your foot, it usually affects the second or third toe. If your baby toe curls instead of buckling, it is also considered a hammer toe. There are two types of hammer toes. If your toes still can move around at the joint, then it is considered a flexible hammer toe. It is a milder form of the condition and there are more treatment options. The other type is called a rigid Hammer toes, which occurs when the tendons in your toe become so rigid that they push your toe joint out of alignment, and it cannot move at all. Typically, you will need surgery to fix it.

Causes
Hammertoes are usually structural in nature. Many times this is the foot structure you were born with and other factors have now made it so that symptoms appear. The muscles in your foot may become unbalanced over time, allowing for a deformity of the small bones in each toe. With longstanding deformity the toe may become rigid. Sometimes one toe is longer than another and this causes a buckling of the digit. A hammertoe may also be caused by other foot deformities such as a bunion. Trauma or other surgery of your foot may predispose you to having the condition if your foot structure is altered.

Symptoms
The symptoms of a hammer toe are usually first noticed when a corn develops on the top of the toe and becomes painful, usually when wearing tight shoes. There may be a bursa under the corn or instead of a corn, depending on the pressure. Most of the symptoms are due to pressure from footwear on the toe. There may be a callus under the metatarsal head at the base of the toe. Initially a hammer toe is usually flexible, but when longstanding it becomes more rigid.

Diagnosis
The exam may reveal a toe in which the near bone of the toe (proximal phalanx) is angled upward and the middle bone of the toe points in the opposite direction (plantar flexed). Toes may appear crooked or rotated. The involved joint may be painful when moved, or stiff. There may be areas of thickened skin (corns or calluses) on top of or between the toes, a callus may also be observed at the tip of the affected toe beneath the toenail. An attempt to passively correct the deformity will help elucidate the best treatment option as the examiner determines whether the toe is still flexible or not. It is advisable to assess palpable pulses, since their presence is associated with a good prognosis for healing after surgery. X-rays will demonstrate the contractures of the involved joints, as well as possible arthritic changes and bone enlargements (exostoses, spurs). X-rays of the involved foot are usually performed in a weight-bearing position.

Non Surgical Treatment
Podiatric Care may include using anti-inflammatory oral medications or an injection of medication and local anesthetic to reduce this swelling. When you go to your doctor, x-rays are usually required to evaluate the structure of your foot, check for fractures and determine the cause. The podiatrist may see you to take care of any corns that develop due to the bone deformities. They may advise you on different shoewear or prescribe a custom made orthotic to try and control the foot structure. Padding techniques may be used to straighten the toe if the deformity is flexible, or pads may be used to lessen the pressure on the area of the corn or ulcer. Your podiatric physician may also recommend a surgical procedure to actually fix the structural problem of your foot.

Surgical Treatment
If you are unable to flex your toe, surgery is the only option to restore movement. Surgery is used to reposition the toe, remove deformed or injured bone, and realign your tendons. Surgery is normally done on an outpatient basis, so you can return home on the day of your surgery.